title: Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study.
abstract: OBJECTIVE
  To assess the long-term efficacy and toxicity of front-line cisplatin-based chemotherapy in patients with stage IIA or IIB testicular seminoma.
  
  
  METHODS
  Untreated patients with pure seminoma of the testis after orchiectomy, with clinical stage IIA or IIB, were considered eligible for this prospective observational study. Chemotherapy consisted of either four cycles of cisplatin and etoposide or three cycles of cisplatin, etoposide, and bleomycin.
  
  
  RESULTS
  Between April 1994 and March 2003, 72 patients were entered onto the study at 26 participating centers. Eighteen patients had stage IIA disease, and 54 patients had stage IIB disease. Eighty-three percent of patients achieved complete response, and 17% achieved partial response with residual mass. After a median follow-up time of 71.5 months, six patients with stage IIB disease experienced relapse, and one of these patients died as a result of seminoma. Three patients experienced non-seminoma-related deaths (two died from a further esophageal carcinoma, and one died from an upper digestive hemorrhage). The estimated 5-year progression-free survival rates for patients with stage IIA or IIB disease were 100% and 87% (95% CI, 77.5% to 97%), respectively. Five-year progression-free and overall survival rates for the whole group were 90% (95% CI, 82% to 98%) and 95% (95% CI, 89% to 100%), respectively. Severe granulocytopenia and thrombocytopenia were observed in eight and two patients, respectively. Mild to moderate emesis, stomatitis, and diarrhea were the most common nonhematologic effects.
  
  
  CONCLUSIONS
  Chemotherapy is a highly effective and well-tolerated treatment for patients with stage IIA or IIB seminoma and represents an available alternative that could avoid some of the serious late effects associated with radiotherapy. Further studies focusing on long-term toxicities of different treatment modalities are needed.
authors.affiliation: Genitourinary Tumors and Sarcoma Unit, Department of Medical Oncology, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain. garciadelmuro@iconcologia.net
authors.forename: Xavier
authors.initials: X
authors.lastname: Garcia-del-Muro
authors.forename: Pablo
authors.initials: P
authors.lastname: Maroto
authors.forename: Josep
authors.initials: J
authors.lastname: Gumà
authors.forename: Javier
authors.initials: J
authors.lastname: Sastre
authors.forename: Marta
authors.initials: M
authors.lastname: López Brea
authors.forename: José A
authors.initials: JA
authors.lastname: Arranz
authors.forename: Nuria
authors.initials: N
authors.lastname: Lainez
authors.forename: Diego
authors.initials: D
authors.lastname: Soto de Prado
authors.forename: Jorge
authors.initials: J
authors.lastname: Aparicio
authors.forename: José M
authors.initials: JM
authors.lastname: Piulats
authors.forename: Xavier
authors.initials: X
authors.lastname: Pérez
authors.forename: Josep R
authors.initials: JR
authors.lastname: Germá-Lluch
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D018239:Seminoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D055815:Young Adult
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin